Case Report. A 66-year-old female presented with new-onset angina and heart failure. Electrocardiography demonstrated chronic atria fibrillation and left axis deviation. Echocardiography demonstrated mild global left ventricular hypokinesia without regional wall motion abnormalities, severe left atrial enlargement, mild mitral regurgitation and mild pulmonary hypertension. Adenosine sestamibi demonstrated a reversible medium-sized anterior and anterolateral perfusion defect. At right heart catheterization, there was mild pulmonary hypertension (systolic: 32 mmHg, diastolic: 11 mmHg, mean 22 mmHg). Coronary angiography revealed a large right-dominant coronary artery that filled the entire left coronary circulation via collaterals. The left main coronary artery arose from the pulmonary trunk (Figure 1). The patient was referred for coronary artery bypass surgery, but has deferred undergoing surgical intervention. The Bland, White and Garland syndrome is a rare congenital coronary anomaly that accounts for approximately 0.5% of congenital coronary abnormalities1 and was first described at autopsy in 1933 in a 3.5-month-old boy who presented with attacks of dyspnea, pallor and profuse sweating.2 Survival into late adulthood is extremely rare and probably depends on the patient’s ability to rapidly develop a collateral arterial circulation.3–9 Surgical reimplantation of the left coronary artery into the ascending aorta is the preferred treatment.10,11
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